Chondroblastoma is an uncommon bone tumor aris- ing from the epiphyseal region of long bones. A review of the literature reveals that the most common locations for this tumor are the knee and proximal humerus (1- 4). The most common age group is the second decade of life. Cases of chondroblastoma of the rib in the literature are few and far between (5- 7); the patients in these re- ports were older than typical patients with epiphyseal chondroblastoma and had an excellent prognosis follow- ing the resection of the tumor. Herein, we report on a case of chondroblastoma of the rib, as well as providing a brief review of the literature. Case Report An otherwise healthy 21-year-old man presented with a six-month history of an expanding mass in his right posterior chest wall causing discomfort during physical activity. During the physical examination, the tumor was palpated and was found to be smooth and non-ten- der. Plain radiography depicted a well-defined bulging cystic mass in the posterior: or arc of the right sixth rib (Fig. 1A). Presumptive clinical diagnoses during this ini- tial period included chondrogenic tumors such as osteo- chondroma and enchondroma, aneurysmal bone cyst and fibrous dysplasia. Computed tomography (CT) showed a 3 2 cm expansile lesion in the right sixth pos- terior rib near the costovertebral junction. There was no periosteal reaction or rim of reactive bone or soft-tissue mass around the lesion. There was a small amount of tiny internal calcification (Fig. 1B). The CT differential diagnoses were enchondroma, osteochondroma, chon- droblastoma and complicated bone cyst. There were no detectable abnormalities in the complete blood count, blood chemistry or electrolytes. A posterior segmental rib resection was performed. The mass, which was ap- proximately 3 cm in diameter, was successfully excised with a safety margin of 1 cm. Grossly, the cortex was thinned but intact. The mass contained brown and yel- lowish tissue intermingled with a cartilaginous granular- gray material that was calcific and nodular. (Fig. 1C). Microscopically, the most cellular portions of the tu- J Korean Radiol Soc 2004;51:95-98 95 Chondroblastoma of the Rib : Case Report 1 Dong Hun Kim, M.D. 1,3 , Kyung Rae Kim, M.D., Sang Wan Ryu, M.D. 2,4 1 Department of Diagnostic Radiology, Armed Forces Kwang Ju Hospital 2 Department of Thoracic Surgery, Armed Forces Kwang Ju Hospital 3 Department of Radiology, Soonchunhyang University Hospital 4 Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital Received February 20, 2004 ; Accepted May 24, 2004 Address reprint requests to : Dong Hun Kim, M.D., Department of Radiology, Soonchunhyang University Medical School 657 Hannam-dong, Youngsan-gu, Seoul 140-743, Korea. Tel. 82-2-790-9396 Fax. 82-2-795-3928 E-mail: [email protected] Chondroblastoma is an uncommon, benign, cartilaginous neoplasm originating in an epiphysis or apophysis of a long tubular bone. The rib is an unusual site for chondrob- lastoma. The authors describe a case of chondroblastoma of the rib and present a brief review of the literature. Index words : Ribs Computed tomography (CT) Bone neoplasms Chondroblastoma
Chondroblastoma of the Rib : Case Report
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095-98±èµ¿ÈÆ(eng)Chondroblastoma is an uncommon bone tumor aris- ing from the epiphyseal region of long bones. A review of the literature reveals that the most common locations for this tumor are the knee and proximal humerus (1- 4). The most common age group is the second decade of life. Cases of chondroblastoma of the rib in the literature are few and far between (5-7); the patients in these re- ports were older than typical patients with epiphyseal chondroblastoma and had an excellent prognosis follow- ing the resection of the tumor. Herein, we report on a case of chondroblastoma of the rib, as well as providing a brief review of the literature.
Case Report
An otherwise healthy 21-year-old man presented with a six-month history of an expanding mass in his right
posterior chest wall causing discomfort during physical activity. During the physical examination, the tumor was palpated and was found to be smooth and non-ten- der. Plain radiography depicted a well-defined bulging cystic mass in the posterior: or arc of the right sixth rib (Fig. 1A). Presumptive clinical diagnoses during this ini- tial period included chondrogenic tumors such as osteo- chondroma and enchondroma, aneurysmal bone cyst and fibrous dysplasia. Computed tomography (CT) showed a 3×2 cm expansile lesion in the right sixth pos- terior rib near the costovertebral junction. There was no periosteal reaction or rim of reactive bone or soft-tissue mass around the lesion. There was a small amount of tiny internal calcification (Fig. 1B). The CT differential diagnoses were enchondroma, osteochondroma, chon- droblastoma and complicated bone cyst. There were no detectable abnormalities in the complete blood count, blood chemistry or electrolytes. A posterior segmental rib resection was performed. The mass, which was ap- proximately 3 cm in diameter, was successfully excised with a safety margin of 1 cm. Grossly, the cortex was thinned but intact. The mass contained brown and yel- lowish tissue intermingled with a cartilaginous granular- gray material that was calcific and nodular. (Fig. 1C).
Microscopically, the most cellular portions of the tu-
J Korean Radiol Soc 2004;51:95-98
95
Chondroblastoma of the Rib : Case Report1
Dong Hun Kim, M.D.1,3, Kyung Rae Kim, M.D., Sang Wan Ryu, M.D.2,4
1Department of Diagnostic Radiology, Armed Forces Kwang Ju Hospital 2Department of Thoracic Surgery, Armed Forces Kwang Ju Hospital 3Department of Radiology, Soonchunhyang University Hospital 4Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital Received February 20, 2004 ; Accepted May 24, 2004 Address reprint requests to : Dong Hun Kim, M.D., Department of Radiology, Soonchunhyang University Medical School 657 Hannam-dong, Youngsan-gu, Seoul 140-743, Korea. Tel. 82-2-790-9396 Fax. 82-2-795-3928 E-mail: [email protected]
Chondroblastoma is an uncommon, benign, cartilaginous neoplasm originating in an epiphysis or apophysis of a long tubular bone. The rib is an unusual site for chondrob- lastoma. The authors describe a case of chondroblastoma of the rib and present a brief review of the literature.
Index words : Ribs Computed tomography (CT) Bone neoplasms Chondroblastoma
mor showed more or less densely packed polygonal chondroblasts. Multinucleated osteoclast-type giant cells were dispersed between the chondroblasts (Fig. 1D). The grossly visible yellow areas of the lesion corre- sponded to foam cell aggregates. The periphery of the tumor showed reactive new bone formation and carti- lage proliferation, as well as focal osteolysis.
Discussion
In 1942, Jaffe and Lichtenstein (1) coined the term “benign chondroblastoma” to describe a variant of giant- cell tumor with cartilage that was previously described by Kolodny, Ewing, and Codman. Benign chondroblas-
Dong Hun Kim, et al: Chondroblastoma of the Rib
96
A B
C D Fig. 1. A 21-year-old man with chondroblastoma of the right sixth rib. A. Plain radiograph shows an expanded posterior rib lesion (arrows). The cortex is thinned-out. The radiolucent mass is character- ized by multiloculated radiolucencies. B. CT of chest demonstrates expanding lesion of posterior sixth rib with a small amount of internal tiny calcification (arrow) within tumor. C. The gross specimen shows the scalloped and thin-walled tumor. There is no extension of the tumor outside of the periosteum. D. Photomicrograph of histologic preparation (hematoxylin-eosin, ×100) shows sheets of chondroblasts with interspersed islands of poorly formed cartilage and scattered osteoclast-type giant cells. There is a highly cellular portion of the tumor with a transition into cartilage.
toma is an uncommon benign tumor, which represents about 1% of all primary bone neoplasms (8). This type of chondroblastoma is usually discovered in the second decade of life and is predominant in males. The most common initial complaint was pain. These tumors are most commonly seen in the proximal tibia and distal fe- mur, followed by the proximal humerus and proximal femur. Radiographically, chondroblastomas are charac- terized by their epiphyseal location, round contour, sharp margin and cortical scalloping buttressed by a rim of reactive bone (1-4). The tumor may extend into the subchondral bone plate or metaphysis. Calcific foci within the lesion are found in approximately 30 to 50 percent of patients. CT may show intralesional stippled calcification of the cartilaginous matrix and is helpful in delineating the anatomic limits of the neoplasm (9).
The rib is an unusual site for chondroblastoma. Nineteen cases have been reported in the literature. The average age of patients with chondroblastoma of the rib is the fourth decade of life, which is higher than that of patients with chondroblastoma of the long bones. However, our patient was only in his twenties. As in larger series, there were more males than females (2:1) in the reported cases of chondroblastoma of the rib (7). Chondroblastoma of the rib may be painful or may pre- sent incidentally. There does not appear to be a predilec- tion for a particular rib or a specific portion of a rib (5- 7, 10). The ossification centers for the rib appear in the second fetal month. There are epiphyseal centers at the head and tubercle of the rib that appear at puberty and ossify in the third decade of life. The epiphyseal plates of the head and tubercle of the rib may be the site of ori- gin of the posterior chondroblastomas; the anterior le- sions may arise from the costochondral junction. The relatively late appearance of these epiphyseal plates may explain the difference in age between patients with chondroblastoma of the rib and patients with chondrob- lastoma at other sites.
Treatment should consist of segmental rib resection without adjuvant therapy. Treatment by resection of the rib yields favorable results. Although the majority of chondroblastomas behave in a benign fashion, local re-
currence and distant metastasis have sometimes been described (10). So, to minimize this risk, it is recom- mended that follow-up radiographs be taken.
The differential diagnosis for an expanding, slow- growing posterior rib lesion includes enchondroma, low-grade chondrosarcoma, metastatic disease, plasma- cytoma and fibrous dysplasia. Also, the following tu- mors or tumor like lesions should be considered: simple bone cyst, osteoblastoma, giant cell tumor, aneurysmal bone cyst, clear cell chondrosarcoma, eosinophilic gran- uloma and infection.
While, in the present case, the site and age of the pa- tient are unusual for chondroblastoma, the radiographic features are consistent with the diagnosis. Although chondroblastoma of the rib is rare, this tumor should be included in the differential diagnosis when the tumor represents a cartilaginous mass.
References
1. Jaffe HL, Lichtenstein L. Benign chondroblastoma of bone: A rein- terpretation of the so-called calcifying or chondromatous giant cell tumor. Am J Pathol 1942;18:969-991
2. Bloem JL, Mulder JD. Chondroblastoma: a clinical and radiological study of 104 cases. Skeletal Radiol 1985;14:1-9
3. Resnick D, Greenway GD. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In Resnick D. Bone and joint imaging. 2nd ed. Philadelphia: Saunders, 1996:1012-1014
4. Schajowicz F, Gallardo H. Epiphysial chondroblastoma of bone. A clinico-pathological study of sixty-nine cases. J Bone Joint Surg Br 1970;52:205-226
5. Mayo-Smith W, Rosenberg AE, Khurana JS, Kattapuram SV, Romero LH. Chondroblastoma of the rib. A case report and review of the literature. Clin Orthop 1990;251:230-234
6. Assor D. Chondroblastoma of the rib. Report of a case. J Bone Joint Surg Am 1973;55:208-210
7. Sundaram M, McGuire MH, Naunheim K, Schajowicz F. Cystic chondroblastoma left 4 th rib. Skeletal Radiol 1988;17:136-140
8. Springfield DS, Capanna R, Gherlinzoni F, Picci P, Campanacci M. Chondroblastoma. A review of seventy cases. J Bone Joint Surg Am 1985;67:748-755
9. Hudson TM, Hawkins IF Jr. Radiological evaluation of chondrob- lastoma. Radiology 1981;139:1-10
10. Khalili K, White LM, Kandel RA, Wunder JS. Chondroblastoma with multiple distant soft tissue metastases. Skeletal Radiol 1997; 26:493-496
J Korean Radiol Soc 2004;51:95-98
97
98
1,3· · 2,4
.
Case Report
An otherwise healthy 21-year-old man presented with a six-month history of an expanding mass in his right
posterior chest wall causing discomfort during physical activity. During the physical examination, the tumor was palpated and was found to be smooth and non-ten- der. Plain radiography depicted a well-defined bulging cystic mass in the posterior: or arc of the right sixth rib (Fig. 1A). Presumptive clinical diagnoses during this ini- tial period included chondrogenic tumors such as osteo- chondroma and enchondroma, aneurysmal bone cyst and fibrous dysplasia. Computed tomography (CT) showed a 3×2 cm expansile lesion in the right sixth pos- terior rib near the costovertebral junction. There was no periosteal reaction or rim of reactive bone or soft-tissue mass around the lesion. There was a small amount of tiny internal calcification (Fig. 1B). The CT differential diagnoses were enchondroma, osteochondroma, chon- droblastoma and complicated bone cyst. There were no detectable abnormalities in the complete blood count, blood chemistry or electrolytes. A posterior segmental rib resection was performed. The mass, which was ap- proximately 3 cm in diameter, was successfully excised with a safety margin of 1 cm. Grossly, the cortex was thinned but intact. The mass contained brown and yel- lowish tissue intermingled with a cartilaginous granular- gray material that was calcific and nodular. (Fig. 1C).
Microscopically, the most cellular portions of the tu-
J Korean Radiol Soc 2004;51:95-98
95
Chondroblastoma of the Rib : Case Report1
Dong Hun Kim, M.D.1,3, Kyung Rae Kim, M.D., Sang Wan Ryu, M.D.2,4
1Department of Diagnostic Radiology, Armed Forces Kwang Ju Hospital 2Department of Thoracic Surgery, Armed Forces Kwang Ju Hospital 3Department of Radiology, Soonchunhyang University Hospital 4Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital Received February 20, 2004 ; Accepted May 24, 2004 Address reprint requests to : Dong Hun Kim, M.D., Department of Radiology, Soonchunhyang University Medical School 657 Hannam-dong, Youngsan-gu, Seoul 140-743, Korea. Tel. 82-2-790-9396 Fax. 82-2-795-3928 E-mail: [email protected]
Chondroblastoma is an uncommon, benign, cartilaginous neoplasm originating in an epiphysis or apophysis of a long tubular bone. The rib is an unusual site for chondrob- lastoma. The authors describe a case of chondroblastoma of the rib and present a brief review of the literature.
Index words : Ribs Computed tomography (CT) Bone neoplasms Chondroblastoma
mor showed more or less densely packed polygonal chondroblasts. Multinucleated osteoclast-type giant cells were dispersed between the chondroblasts (Fig. 1D). The grossly visible yellow areas of the lesion corre- sponded to foam cell aggregates. The periphery of the tumor showed reactive new bone formation and carti- lage proliferation, as well as focal osteolysis.
Discussion
In 1942, Jaffe and Lichtenstein (1) coined the term “benign chondroblastoma” to describe a variant of giant- cell tumor with cartilage that was previously described by Kolodny, Ewing, and Codman. Benign chondroblas-
Dong Hun Kim, et al: Chondroblastoma of the Rib
96
A B
C D Fig. 1. A 21-year-old man with chondroblastoma of the right sixth rib. A. Plain radiograph shows an expanded posterior rib lesion (arrows). The cortex is thinned-out. The radiolucent mass is character- ized by multiloculated radiolucencies. B. CT of chest demonstrates expanding lesion of posterior sixth rib with a small amount of internal tiny calcification (arrow) within tumor. C. The gross specimen shows the scalloped and thin-walled tumor. There is no extension of the tumor outside of the periosteum. D. Photomicrograph of histologic preparation (hematoxylin-eosin, ×100) shows sheets of chondroblasts with interspersed islands of poorly formed cartilage and scattered osteoclast-type giant cells. There is a highly cellular portion of the tumor with a transition into cartilage.
toma is an uncommon benign tumor, which represents about 1% of all primary bone neoplasms (8). This type of chondroblastoma is usually discovered in the second decade of life and is predominant in males. The most common initial complaint was pain. These tumors are most commonly seen in the proximal tibia and distal fe- mur, followed by the proximal humerus and proximal femur. Radiographically, chondroblastomas are charac- terized by their epiphyseal location, round contour, sharp margin and cortical scalloping buttressed by a rim of reactive bone (1-4). The tumor may extend into the subchondral bone plate or metaphysis. Calcific foci within the lesion are found in approximately 30 to 50 percent of patients. CT may show intralesional stippled calcification of the cartilaginous matrix and is helpful in delineating the anatomic limits of the neoplasm (9).
The rib is an unusual site for chondroblastoma. Nineteen cases have been reported in the literature. The average age of patients with chondroblastoma of the rib is the fourth decade of life, which is higher than that of patients with chondroblastoma of the long bones. However, our patient was only in his twenties. As in larger series, there were more males than females (2:1) in the reported cases of chondroblastoma of the rib (7). Chondroblastoma of the rib may be painful or may pre- sent incidentally. There does not appear to be a predilec- tion for a particular rib or a specific portion of a rib (5- 7, 10). The ossification centers for the rib appear in the second fetal month. There are epiphyseal centers at the head and tubercle of the rib that appear at puberty and ossify in the third decade of life. The epiphyseal plates of the head and tubercle of the rib may be the site of ori- gin of the posterior chondroblastomas; the anterior le- sions may arise from the costochondral junction. The relatively late appearance of these epiphyseal plates may explain the difference in age between patients with chondroblastoma of the rib and patients with chondrob- lastoma at other sites.
Treatment should consist of segmental rib resection without adjuvant therapy. Treatment by resection of the rib yields favorable results. Although the majority of chondroblastomas behave in a benign fashion, local re-
currence and distant metastasis have sometimes been described (10). So, to minimize this risk, it is recom- mended that follow-up radiographs be taken.
The differential diagnosis for an expanding, slow- growing posterior rib lesion includes enchondroma, low-grade chondrosarcoma, metastatic disease, plasma- cytoma and fibrous dysplasia. Also, the following tu- mors or tumor like lesions should be considered: simple bone cyst, osteoblastoma, giant cell tumor, aneurysmal bone cyst, clear cell chondrosarcoma, eosinophilic gran- uloma and infection.
While, in the present case, the site and age of the pa- tient are unusual for chondroblastoma, the radiographic features are consistent with the diagnosis. Although chondroblastoma of the rib is rare, this tumor should be included in the differential diagnosis when the tumor represents a cartilaginous mass.
References
1. Jaffe HL, Lichtenstein L. Benign chondroblastoma of bone: A rein- terpretation of the so-called calcifying or chondromatous giant cell tumor. Am J Pathol 1942;18:969-991
2. Bloem JL, Mulder JD. Chondroblastoma: a clinical and radiological study of 104 cases. Skeletal Radiol 1985;14:1-9
3. Resnick D, Greenway GD. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In Resnick D. Bone and joint imaging. 2nd ed. Philadelphia: Saunders, 1996:1012-1014
4. Schajowicz F, Gallardo H. Epiphysial chondroblastoma of bone. A clinico-pathological study of sixty-nine cases. J Bone Joint Surg Br 1970;52:205-226
5. Mayo-Smith W, Rosenberg AE, Khurana JS, Kattapuram SV, Romero LH. Chondroblastoma of the rib. A case report and review of the literature. Clin Orthop 1990;251:230-234
6. Assor D. Chondroblastoma of the rib. Report of a case. J Bone Joint Surg Am 1973;55:208-210
7. Sundaram M, McGuire MH, Naunheim K, Schajowicz F. Cystic chondroblastoma left 4 th rib. Skeletal Radiol 1988;17:136-140
8. Springfield DS, Capanna R, Gherlinzoni F, Picci P, Campanacci M. Chondroblastoma. A review of seventy cases. J Bone Joint Surg Am 1985;67:748-755
9. Hudson TM, Hawkins IF Jr. Radiological evaluation of chondrob- lastoma. Radiology 1981;139:1-10
10. Khalili K, White LM, Kandel RA, Wunder JS. Chondroblastoma with multiple distant soft tissue metastases. Skeletal Radiol 1997; 26:493-496
J Korean Radiol Soc 2004;51:95-98
97
98
1,3· · 2,4
.
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